Provider Demographics
NPI:1154652634
Name:PEREZ, JOHN GABRIEL (LPCC-S)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:GABRIEL
Last Name:PEREZ
Suffix:
Gender:M
Credentials:LPCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3481 UNIVERSITY DR S STE 104
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-6235
Mailing Address - Country:US
Mailing Address - Phone:701-541-0313
Mailing Address - Fax:
Practice Address - Street 1:3481 UNIVERSITY DR S STE 104
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-6235
Practice Address - Country:US
Practice Address - Phone:701-541-0313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-22
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND666-9-1-10-243101Y00000X, 101YP2500X
MNCC01903101Y00000X, 101YP2500X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No171M00000XOther Service ProvidersCase Manager/Care Coordinator